Posted: January 8th, 2022

Artificial Coma Versus Natural Coma: Discuss Its Impact

Artificial Coma Versus Natural Coma: Discuss Its Impact

A coma is a state of prolonged unconsciousness that can be caused by various factors or induced by medical intervention. In this blog post, we will compare and contrast natural coma and artificial coma, and discuss their impact on the brain and the body.

What Is a Natural Coma?

A natural coma is a deep state of unconsciousness that occurs due to a brain injury or a disturbance in brain circulation. The person in a natural coma is unresponsive to external or internal stimuli and cannot be awakened. This state can last from a few days to several years, or even result in death.

The causes of natural coma include:

– Anoxic brain injury: a condition that deprives the brain of oxygen supply, which can occur due to cardiac arrest, choking, drowning, or carbon monoxide poisoning.
– Traumatic brain injury: a physical damage to the brain caused by a blunt force, a penetrating object, or a blast wave, which can result in bleeding and swelling of the brain.
– Stroke: a disruption of blood flow to a part of the brain, either due to a blockage (ischemic stroke) or a rupture (hemorrhagic stroke), which can cause cell death and tissue damage.
– Hyperglycemia: a persistent high level of blood sugar, which can lead to dehydration, electrolyte imbalance, and ketoacidosis, affecting the brain function.
– Infections: inflammation of the brain or its membranes, such as meningitis or encephalitis, which can be caused by bacteria, viruses, fungi, or parasites.
– Toxins: accumulation of harmful substances in the body due to impaired functioning of the organs, such as ammonia, urea, or carbon dioxide, which can affect the brain metabolism and pH.
– Drug or alcohol overdose: ingestion of excessive amounts of substances that can alter the brain chemistry and neurotransmission, such as opioids, sedatives, stimulants, or alcohol.
– Seizures: abnormal electrical activity in the brain that can cause convulsions, loss of consciousness, or altered mental state. Repeated or prolonged seizures can prevent the brain from recovering between attacks and lead to coma.

How Is Natural Coma Managed?

The management of natural coma depends on the cause and the severity of the condition. The main goals are to stabilize the vital signs, prevent further brain damage, and support the recovery process. The interventions may include:

– Airway management: ensuring adequate oxygen delivery to the brain by intubating the patient or performing a tracheostomy if needed.
– Fluid and electrolyte balance: correcting dehydration, acidosis, or electrolyte abnormalities by administering intravenous fluids and medications.
– Blood pressure control: maintaining an optimal blood pressure level by using vasopressors or antihypertensives as needed.
– Intracranial pressure reduction: lowering the pressure inside the skull by using medications such as mannitol or hypertonic saline, draining cerebrospinal fluid through a ventriculostomy, or performing a craniotomy to remove a part of the skull.
– Temperature regulation: preventing hyperthermia or hypothermia by using cooling blankets or warming devices as needed.
– Seizure prevention: administering anticonvulsants such as phenytoin or levetiracetam to stop or reduce seizure activity.
– Infection control: treating any underlying infection with antibiotics or antivirals as appropriate.
– Nutrition support: providing adequate calories and protein through enteral or parenteral feeding as appropriate.
– Rehabilitation: initiating early physical therapy, occupational therapy, speech therapy, or cognitive therapy to stimulate the brain function and improve the outcome.

What Is an Artificial Coma?

An artificial coma is a medically induced state of unconsciousness that is used to protect the brain from further damage. It is achieved by administering drugs that suppress the brain activity and induce a similar pattern to that of natural coma on an electroencephalogram (EEG). Unlike natural coma, artificial coma is reversible and can be stopped by discontinuing the drugs.

The indications for artificial coma include:

– Traumatic brain injury: to reduce the metabolic demand of the brain and prevent secondary injury due to increased intracranial pressure or cerebral edema.
– Status epilepticus: to stop refractory seizures that do not respond to conventional anticonvulsants.
– Ischemic stroke: to preserve the penumbra (the area of potentially salvageable tissue around the infarct) and improve the neurological outcome.
– Subarachnoid hemorrhage: to prevent vasospasm (narrowing of blood vessels) and delayed cerebral ischemia.
– Malignant hyperthermia: to treat a rare but life-threatening reaction to certain anesthetics that causes muscle rigidity, fever, and rhabdomyolysis (breakdown of muscle tissue).
– Cardiac arrest: to improve the survival and neurological outcome by reducing the brain oxygen consumption and preventing reperfusion injury.

How Is Artificial Coma Performed?

The drugs used to induce artificial coma are usually sedatives, such as propofol, midazolam, or pentobarbital, or anesthetics, such as ketamine or isoflurane. The choice and dose of the drug depend on the patient’s condition, the desired depth of coma, and the potential side effects. The drugs are administered intravenously or by inhalation and are continuously monitored by an EEG to ensure adequate suppression of brain activity.

The duration of artificial coma varies depending on the indication and the response of the patient. It can range from a few hours to a few weeks. The potential complications of artificial coma include:

– Hypotension: low blood pressure due to the vasodilatory effect of the drugs, which can impair the cerebral perfusion and worsen the brain injury.
– Respiratory depression: reduced breathing rate and depth due to the sedative effect of the drugs, which can cause hypoxia (low oxygen level) and hypercapnia (high carbon dioxide level) in the blood.
– Infection: increased risk of infection due to the impaired immune system, the invasive procedures, and the prolonged hospitalization.
– Thromboembolism: formation of blood clots in the veins due to the reduced blood flow and mobility, which can cause pulmonary embolism (blockage of an artery in the lung) or stroke.
– Withdrawal syndrome: symptoms such as agitation, anxiety, tremors, or seizures that occur when the drugs are stopped abruptly, which can be prevented by tapering off the drugs gradually.

How Long Does It Take To Recover From an Artificial Coma?

The recovery from an artificial coma depends on several factors, such as the cause and extent of the brain injury, the duration and depth of the coma, and the presence of any complications. The recovery process can be divided into four stages:

– Eye opening: the first sign of recovery is when the patient opens his or her eyes spontaneously or in response to a stimulus. This can occur within hours or days after stopping the drugs.
– Consciousness: the next sign of recovery is when the patient regains awareness of himself or herself and the environment. This can occur within days or weeks after eye opening.
– Communication: the next sign of recovery is when the patient can communicate verbally or nonverbally with others. This can occur within weeks or months after regaining consciousness.
– Functional recovery: the final sign of recovery is when the patient can perform daily activities independently or with minimal assistance. This can occur within months or years after regaining communication.

What Is the Outlook for Coma in General?

The outlook for coma in general is variable and depends on many factors, such as:

– The cause and severity of the coma
– The age and health status of the patient
– The duration and depth of the coma
– The presence and treatment of any complications
– The quality and timing of rehabilitation

Some general statistics are:

– About 40% of patients who are in a coma for more than 24 hours die
– About 25% of patients who survive a coma remain in a vegetative state (a state of wakefulness without awareness)
– About 10% of patients who survive a coma remain in a minimally conscious state (a state of partial awareness)
– About 15% of patients who survive a coma recover fully or with minor impairments
– About 10% of patients who survive a coma recover with moderate impairments
– About 40% of patients who survive a coma recover with severe impairments

Conclusion

A coma is a state of prolonged unconsciousness that can be natural or artificial. Natural coma is caused by various factors that damage or disrupt the brain function. Artificial coma is induced by medical intervention to protect the brain from further damage. Both types of coma have significant impact on the brain and the body, and require intensive care and rehabilitation. The recovery from coma is unpredictable and depends on many factors. The outcome can range from full recovery to death.

References

[1] Nidadavolu S, Juneja A. Natural Coma Versus Artificial Coma. iCliniq. 2023 Feb 06. Available from: https://www.icliniq.com/articles/neurological-health/natural-coma-versus-artificial-coma

[2] Biello D. What Is a Medically Induced Coma and Why Is It Used? Scientific American. 2011 Jan 11. Available from: https://www.scientificamerican.com/article/what-is-a-medically-induced-coma/

[3] WebMD. Coma: Types, Causes, Treatments, Prognosis. WebMD. 2020 Dec 08. Available from: https://www.webmd.com/brain/coma-types-causes-treatments-prognosis

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